Question

A patient of mine with euthyroid Hashimoto's thyroiditis was noted to have a single nodule on sonogram; FNAB showed follicular cells with Hurthle cell change and colloid, consistent with Hurthle cell metaplasia within a nodular goiter. As a pediatric endocrinologist, I am not particularly experienced with analyzing these results. Is this just Hashimoto's or something else that I should be concerned about?

Ian Marshall, MD

Response

I hesitate to be too specific, since I am not a pathologist, and have not seen the slides. But--- nodular areas with Hurthle cells, normal follicular cells, colloid and lymphocytes are common in Hashimoto's thyroiditis, and may present as nodules on exam and by US. I believe an FNA with only Hurthle cells from a lesion that is a very distinct single nodule on US, would be suggestive of a growth. But one with all of the other components, including lymphocytes, especially if there are other slightly nodular areas in the gland, would be typical of Hashimoto's, and not alarming.